ORIGINAL SCIENTIFIC REPORT
Advancement Flap for Treatment of Complex Cryptoglandular
Anal Fistula: Prediction of Therapy Success or Failure Using
Anamnestic and Clinical Parameters
Published online: 23 March 2017
Internationale de Chirurgie 2017
Background Multiple new procedures for treatment of complex anal ﬁstula have been described in the past decades,
but an ideal single technique has yet not been identiﬁed. Factors that predict the outcome are required to identify the
best procedure for each individual patient. The aim of this study was to ﬁnd those predictors for advancement ﬂap at
Methods From 2012 to 2015 in a tertiary university clinic, all patients who underwent advancement ﬂap for treat-
ment of complex cryptoglandular ﬁstula were prospectively enrolled. Pre- and postoperatively standardized
anamnestic and clinical examinations were performed. Predictive factors for therapy failure were identiﬁed using
univariate and multivariate analysis.
Results Out of 65 patients, 61 (93%) completed all examinations and were included in the study. Therapy failure
after a mean follow-up period of 25 months occurred in total n = 11 patients (18%). There was no signiﬁcant
disturbance of continence among the entire study cohort as shown by the incontinence score (preop 0.34 ± 0.91 pts.,
postop 0.37 ± 0.97 pts.; p = 0.59). Univariate analysis for risk factors for therapy failure revealed age (p = 0.004),
history of surgical abscess drainage (p = 0.04), BMI (p = 0.002), suprasphincteric ﬁstula (p = 0.019) and horseshoe
abscess (p = 0.036) as independent parameters for therapy failure. During multivariate analysis, only history of
surgical abscess drainage (OR = 8.09, p = 0.048, 95% CI 0.98–64.96), suprasphincteric ﬁstula (OR = 6.83,
p = 0.032, 95% CI 1.17–6.83) and BMI (OR = 1.23, p = 0.017, 95% CI 1.03–1.46) were independent parameters
for therapy failure.
Conclusion Advancement ﬂap for treatment of complex ﬁstula is effective and has low risk of disturbed continence.
BMI, suprasphincteric ﬁstula and history of surgical abscess drainage are predictors for therapy failure.
Anal ﬁstula is a common disorder in coloproctologist’s
practice with an incidence of 5.6 per 100,000 in women
and 12.3 per 100,000 in men .
While the majority of anal ﬁstulas are simple, superﬁcial
and easily treatable, treatment of complex anal ﬁstulas is
still challenging because of risk of recurrence and potential
aggravation of continence after surgery . Fistulotomy as
classical procedure for treatment of anal ﬁstula is effective,
but may lead in cases of complex ﬁstula in up to 45% to
& Lars Boenicke
Department of General and Visceral Surgery, Helios
University Hospital Wuppertal, University Witten-Herdecke,
Heusnerstraße 40, 42283 Wuppertal, Germany
Centre of Coloproctology, Wuppertal, Germany
World J Surg (2017) 41:2395–2400